(305 ILCS 5/5-43) Sec. 5-43. Supports Waiver Program for Young Adults with Developmental Disabilities. (a) The Department of Human Services' Division of Developmental Disabilities, in partnership with the Department of Healthcare and Family Services and stakeholders, shall study the development and implementation of a supports waiver program for young adults with developmental disabilities. The Division shall explore the following components of a supports waiver program to determine what is most appropriate: (1) The age of individuals to be provided services in | ||
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(2) The number of individuals to be provided services | ||
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(3) The services to be provided in a waiver program. (4) The funding to be provided to individuals within | ||
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(5) The transition process to the Waiver for Adults | ||
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(6) The type of home and community-based services | ||
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(b) The Department of Human Services and the Department of Healthcare and Family Services are authorized to adopt and implement any rules necessary to study the supports waiver program. (c) Subject to appropriation, no later than January 1, 2024, the Department of Healthcare and Family Services shall apply to the federal Centers for Medicare and Medicaid Services for a supports waiver for young adults with developmental disabilities utilizing the information learned from the study under subsection (a).
(Source: P.A. 102-43, eff. 7-6-21.) |
(305 ILCS 5/5-44)
Sec. 5-44. Screening, Brief Intervention, and Referral to Treatment. As used in this Section, "SBIRT" means a comprehensive, integrated, public health approach to the delivery of early intervention and treatment
services for persons who are at risk of developing substance use disorders or have substance use disorders including, but not limited to, an addiction to alcohol, opioids,
tobacco, or cannabis.
SBIRT services include all of the following: (1) Screening to quickly assess the severity of | ||
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(2) Brief intervention focused on increasing insight | ||
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(3) Referral to treatment provided to those | ||
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SBIRT services may include, but are not limited to, the following settings and programs: primary care centers, hospital emergency rooms, hospital in-patient units,
trauma centers, community behavioral health programs, and other community settings that provide opportunities for early intervention with at-risk substance users before more severe
consequences occur. The Department of Healthcare and Family Services shall develop and seek federal approval of a SBIRT benefit for which
qualified providers shall be reimbursed under the medical assistance program. In conjunction with the Department of Human Services' Division of Substance Use Prevention and Recovery, the Department of Healthcare and
Family Services may develop a methodology and reimbursement rate for SBIRT services provided by qualified providers in approved
settings. For opioid specific SBIRT services provided in a hospital emergency department, the Department of Healthcare and
Family Services shall develop a bundled reimbursement
methodology and rate for a package of opioid treatment services, which include initiation of medication for the treatment of opioid use disorder in
the emergency department setting, including assessment, referral to ongoing care, and arranging access to supportive services when necessary. This
package of opioid related services shall be billed on a separate claim and shall be reimbursed outside of the Enhanced Ambulatory Patient
Grouping system.
(Source: P.A. 102-598, eff. 1-1-22; 102-813, eff. 5-13-22.)
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(305 ILCS 5/5-45) Sec. 5-45. Reimbursement rates; substance use disorder
treatment providers and facilities. Beginning on July 1, 2022,
the Department of Human Services' Division of Substance Use
Prevention and Recovery in conjunction with the Department of
Healthcare and Family Services, shall provide for an increase
in reimbursement rates by way of an increase to existing rates of
47% for all community-based substance use disorder treatment
services, including, but not limited to, all of the following: (1) Admission and Discharge Assessment. (2) Level 1 (Individual). (3) Level 1 (Group). (4) Level 2 (Individual). (5) Level 2 (Group). (6) Psychiatric/Diagnostic. (7) Medication Monitoring (Individual). (8) Methadone as an Adjunct to Treatment. No existing or future reimbursement rates or add-ons shall be
reduced or changed to address the rate increase proposed under this Section.
The Department of Healthcare and Family Services shall immediately,
no later than 3 months following April 19, 2022 (the effective date of Public Act 102-699),
submit any necessary application to the federal Centers for Medicare
and Medicaid Services for a waiver or State Plan amendment to implement the requirements of this Section.
Beginning in State fiscal year 2023, and every State fiscal year thereafter,
reimbursement rates for those community-based substance use disorder
treatment services shall be adjusted upward by an amount equal
to the Consumer Price Index-U from the previous year, not to
exceed 2% in any State fiscal year. If there is a decrease in
the Consumer Price Index-U, rates shall remain unchanged for
that State fiscal year. The Department of Human Services shall adopt rules,
including emergency rules under Section 5-45.1 of the Illinois
Administrative Procedure Act, to implement the provisions of
this Section. As used in this Section, "consumer price index-u"
means the index published by the Bureau of Labor Statistics of
the United States Department of Labor that measures the average
change in prices of goods and services purchased by all urban
consumers, United States city average, all items, 1982-84 =
100.
(Source: P.A. 102-699, eff. 4-19-22; 103-154, eff. 6-30-23.) |
(305 ILCS 5/5-46) Sec. 5-46. General acute care hospitals. A general acute care hospital is authorized to file a notice with the Department of Public Health and the Health Facilities and Services Review Board to establish an acute mental illness category of service in accordance with the Illinois Health Facilities Planning Act and add authorized acute mental illness beds if the following conditions are met: (1) the general acute care hospital qualifies as a | ||
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(2) the notice seeks to establish no more than 24 | ||
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(3) the notice seeks to reduce the number of | ||
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(Source: P.A. 102-886, eff. 5-17-22; 103-154, eff. 6-30-23.) |
(305 ILCS 5/5-47) Sec. 5-47. Medicaid reimbursement rates; substance use disorder treatment providers and facilities. (a) Beginning on January 1, 2024, subject to federal approval, the Department of Healthcare and Family Services, in conjunction with the Department of Human Services' Division of Substance Use Prevention and Recovery, shall provide a 30% increase in reimbursement rates for all Medicaid-covered ASAM Level 3 residential/inpatient substance use disorder treatment services. No existing or future reimbursement rates or add-ons shall be reduced or changed to address this proposed rate increase. No later than 3 months after June 16, 2023 (the effective date of Public Act 103-102), the Department of Healthcare and Family Services shall submit any necessary application to the federal Centers for Medicare and Medicaid Services to implement the requirements of this Section. (a-5) Beginning in State fiscal year 2025, and every State fiscal year thereafter, reimbursement rates for licensed or certified substance use disorder treatment providers of ASAM Level 3 residential/inpatient services for persons with substance use disorders shall be adjusted upward by an amount equal to the Consumer Price Index-U from the previous year, not to exceed 2% in any State fiscal year. If there is a decrease in the Consumer Price Index-U, rates shall remain unchanged for that State fiscal year. The Department shall adopt rules, including emergency rules, in accordance with the Illinois Administrative Procedure Act, to implement the provisions of this Section. As used in this Section, "Consumer Price Index-U" means the index published by the Bureau of Labor Statistics of the United States Department of Labor that measures the average change in prices of goods and services purchased by all urban consumers, United States city average, all items, 1982-84 = 100. (b) Parity in community-based behavioral health rates; implementation plan for cost reporting. For the purpose of understanding behavioral health services cost structures and their impact on the Medical Assistance Program, the Department of Healthcare and Family Services shall engage stakeholders to develop a plan for the regular collection of cost reporting for all entity-based substance use disorder providers. Data shall be used to inform on the effectiveness and efficiency of Illinois Medicaid rates. The Department and stakeholders shall develop a plan by April 1, 2024. The Department shall engage stakeholders on implementation of the plan. The plan, at minimum, shall consider all of the following: (1) Alignment with certified community behavioral | ||
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(2) Inclusion of prospective costs to measure what is | ||
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(3) Consideration of differences in collection and | ||
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(4) Consideration of additional administrative time | ||
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(5) Goals, purposes, and usage of data collected from | ||
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(6) Inclusion of qualitative data in addition to | ||
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(7) Technical assistance for providers for completing | ||
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(8) Implementation of a timeline which allows an | ||
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Details from collected cost reports shall be made publicly available on the Department's website and costs shall be used to ensure the effectiveness and efficiency of Illinois Medicaid rates. (c) Reporting; access to substance use disorder treatment services and recovery supports. By no later than April 1, 2024, the Department of Healthcare and Family Services, with input from the Department of Human Services' Division of Substance Use Prevention and Recovery, shall submit a report to the General Assembly regarding access to treatment services and recovery supports for persons diagnosed with a substance use disorder. The report shall include, but is not limited to, the following information: (1) The number of providers enrolled in the Illinois | ||
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(2) The number of Medicaid customers in Illinois with | ||
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(3) A comparison of Illinois' substance use disorder | ||
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(4) Recommendations for and an analysis of the impact | ||
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(5) Recommendations for expanding substance use | ||
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(Source: P.A. 103-102, eff. 6-16-23; 103-588, eff. 6-5-24; 103-605, eff. 7-1-24.) |
(305 ILCS 5/5-48) Sec. 5-48. Increasing behavioral health service capacity in federally qualified health centers. The Department of Healthcare and Family Services shall develop policies and procedures with the goal of increasing the capacity of behavioral health services provided by federally qualified health centers as defined in Section 1905(l)(2)(B) of the federal Social Security Act. Subject to federal approval, the Department shall develop, no later than January 1, 2024, billing policies that provide reimbursement to federally qualified health centers for services rendered by graduate-level, sub-clinical behavioral health professionals who deliver care under the supervision of a fully licensed behavioral health clinician who is licensed as a clinical social worker, clinical professional counselor, marriage and family therapist, or clinical psychologist. To be eligible for reimbursement as provided for in this Section, a graduate-level, sub-clinical professional must meet the educational requirements set forth by the Department of Financial and Professional Regulation for licensed clinical social workers, licensed clinical professional counselors, licensed marriage and family therapists, or licensed clinical psychologists. An individual seeking to fulfill post-degree experience requirements in order to qualify for licensing as a clinical social worker, clinical professional counselor, marriage and family therapist, or clinical psychologist shall also be eligible for reimbursement under this Section so long as the individual is in compliance with all applicable laws and regulations regarding supervision, including, but not limited to, the requirement that the supervised experience be under the order, control, and full professional responsibility of the individual's supervisor or that the individual is designated by a title that clearly indicates training status. The Department shall work with a trade association representing a majority of federally qualified health centers operating in Illinois to develop the policies and procedures required under this Section. (Source: P.A. 103-102, eff. 1-1-24 .) |
(305 ILCS 5/5-49) Sec. 5-49. Long-acting reversible contraception. Subject to federal approval, the Department shall adopt policies and rates for long-acting reversible contraception by January 1, 2024 to ensure that reimbursement is not reduced by 4.4% below list price. The Department shall submit any necessary application to the federal Centers for Medicare and Medicaid Services for the purposes of implementing such policies and rates.
(Source: P.A. 103-102, eff. 7-1-23.) |
(305 ILCS 5/5-50) Sec. 5-50. Coverage for mental health and substance use disorder telehealth services. (a) As used in this Section: "Behavioral health care professional" has the meaning given to "health care professional" in Section 5 of the Telehealth Act, but only with respect to professionals licensed or certified by the Division of Mental Health or Division of Substance Use Prevention and Recovery of the Department of Human Services engaged in the delivery of mental health or substance use disorder treatment or services. "Behavioral health facility" means a community mental health center, a behavioral health clinic, a substance use disorder treatment program, or a facility or provider licensed or certified by the Division of Mental Health or Division of Substance Use Prevention and Recovery of the Department of Human Services. "Behavioral telehealth services" has the meaning given to the term "telehealth services" in Section 5 of the Telehealth Act, but limited solely to mental health and substance use disorder treatment or services to a patient, regardless of patient location. "Distant site" has the meaning given to that term in Section 5 of the Telehealth Act. "Originating site" has the meaning given to that term in Section 5 of the Telehealth Act. (b) The Department and any managed care plans under contract with the Department for the medical assistance program shall provide for coverage of mental health and substance use disorder treatment or services delivered as behavioral telehealth services as specified in this Section. The Department and any managed care plans under contract with the Department for the medical assistance program may also provide reimbursement to a behavioral health facility that serves as the originating site at the time a behavioral telehealth service is rendered. (c) To ensure behavioral telehealth services are equitably provided, coverage required under this Section shall comply with all of the following: (1) The Department and any managed care plans under | ||
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(A) require that in-person contact occur between | ||
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(B) require patients, behavioral health care | ||
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(C) require the use of behavioral telehealth | ||
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(D) require the use of behavioral telehealth | ||
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(E) require a behavioral health care professional | ||
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(F) create geographic or facility restrictions or | ||
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(G) require behavioral health care professionals | ||
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(H) require patients to use behavioral telehealth | ||
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(I) impose upon behavioral telehealth services | ||
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(2) Any cost sharing applicable to services provided | ||
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(3) The Department and any managed care plans under | ||
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(d) For purposes of reimbursement, the Department and any managed care plans under contract with the Department for the medical assistance program shall reimburse a behavioral health care professional or behavioral health facility for behavioral telehealth services on the same basis, in the same manner, and at the same reimbursement rate that would apply to the services if the services had been delivered via an in-person encounter by a behavioral health care professional or behavioral health facility. This subsection applies only to those services provided by behavioral telehealth that may otherwise be billed as an in-person service. (e) Behavioral health care professionals and behavioral health facilities shall determine the appropriateness of specific sites, technology platforms, and technology vendors for a behavioral telehealth service, as long as delivered services adhere to all federal and State privacy, security, and confidentiality laws, rules, or regulations, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996, 42 CFR Part 2, and the Mental Health and Developmental Disabilities Confidentiality Act. (f) Nothing in this Section shall be deemed as precluding the Department and any managed care plans under contract with the Department for the medical assistance program from providing benefits for other telehealth services. (g) There shall be no restrictions on originating site requirements for behavioral telehealth coverage or reimbursement to the distant site under this Section other than requiring the behavioral telehealth services to be medically necessary and clinically appropriate. (h) Nothing in this Section shall be deemed as precluding the Department and any managed care plans under contract with the Department for the medical assistance program from establishing limits on the use of telehealth for a particular behavioral health service when the limits are consistent with generally accepted standards of mental, emotional, nervous, or substance use disorder or condition care. (i) The Department may adopt rules to implement the provisions of this Section. (Source: P.A. 103-243, eff. 1-1-24; 103-605, eff. 7-1-24.) |
(305 ILCS 5/5-51) Sec. 5-51. Proton beam therapy; managed care. Notwithstanding any other provision of this Article, a managed care organization under contract with the Department to provide services to recipients of medical assistance shall provide coverage for proton beam therapy. As used in this Section: "Proton beam therapy" means a type of radiation therapy treatment that utilizes protons as the radiation delivery method for the treatment of tumors and cancerous cells. "Radiation therapy treatment" means the delivery of biological effective doses with proton therapy, intensity modulated radiation therapy, brachytherapy, stereotactic body radiation therapy, three-dimensional conformal radiation therapy, or other forms of therapy using radiation. (Source: P.A. 103-325, eff. 1-1-24; 103-605, eff. 7-1-24.) |
(305 ILCS 5/5-53) Sec. 5-53. Coverage for self-measure blood pressure monitoring services. Subject to federal approval and notwithstanding any other provision of this Code, for services on and after January 1, 2025, the following self-measure blood pressure monitoring services shall be covered and reimbursed under the medical assistance program for persons who are otherwise eligible for medical assistance under this Article: (1) patient education and training services on the | ||
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(2) separate self-measurement readings and the | ||
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(Source: P.A. 103-593, eff. 6-7-24.) |
(305 ILCS 5/5-55) Sec. 5-55. Reimbursement for music therapy services. Subject to federal approval, for dates of service beginning on and after July 1, 2025, the Department shall reimburse music therapy services provided by licensed professional music therapists. To be eligible for reimbursement under this Section, music therapy services must be provided by a licensed professional music therapist authorized to practice under the Music Therapy Licensing and Practice Act.
(Source: P.A. 103-593, eff. 6-7-24.) |
(305 ILCS 5/5-60) Sec. 5-60. Optometric services; reimbursement rates. Notwithstanding any other law or rule to the contrary and subject to federal approval, for dates of service beginning on and after January 1, 2025, the reimbursement rates for optometric and optical services for determining refractive state, fitting of spectacles, and fitting of bifocal spectacles shall be increased by 35% above the rates in effect on January 1, 2024.
(Source: P.A. 103-593, eff. 6-7-24.) |
(305 ILCS 5/Art. V-A heading) ARTICLE V-A.
HOSPITAL PROVIDER FUNDING
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(305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1)
Sec. 5A-1. Definitions. As used in this Article, unless the context requires
otherwise:
"Fund" means the Hospital Provider Fund.
"Hospital" means an institution, place, building, or agency located in this
State that is subject to licensure by the Illinois Department of Public Health
under the Hospital Licensing Act, whether public or private and whether
organized for profit or not-for-profit.
"Hospital provider" means a person licensed by the Department of Public
Health to conduct, operate, or maintain a hospital, regardless of whether the
person is a Medicaid provider. For purposes of this paragraph, "person" means
any political subdivision of the State, municipal corporation, individual,
firm, partnership, corporation, company, limited liability company,
association, joint stock association, or trust, or a receiver, executor,
trustee, guardian, or other representative appointed by order of any court.
"Medicare bed days" means, for each hospital, the sum of the number of days that each bed was occupied by a patient who was covered by Title XVIII of the Social Security Act, excluding days attributable to the routine services provided to persons receiving skilled or intermediate long term care services. Medicare bed days shall be computed separately for each hospital operated or maintained by a hospital provider. "Occupied bed days" means the sum of the number of days
that each bed was occupied by a patient for all beds, excluding days attributable to the routine services provided to persons receiving skilled or intermediate long term care services. Occupied bed days shall be computed separately for each
hospital operated or maintained by a hospital provider. "Outpatient gross revenue" means, for each hospital, its total gross charges attributed to outpatient services as reported on the Medicare cost report at Worksheet C, Part I, Column 7, line 101, less the sum of lines 45, 60, 63, 64, 65, 66, 67, and 68 (and any subsets of those lines).
(Source: P.A. 97-688, eff. 6-14-12; 97-689, eff. 6-14-12.)
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(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) (Section scheduled to be repealed on December 31, 2026) Sec. 5A-2. Assessment.
(a)(1)
Subject to Sections 5A-3 and 5A-10, for State fiscal years 2009 through 2018, or as long as continued under Section 5A-16, an annual assessment on inpatient services is imposed on each hospital provider in an amount equal to $218.38 multiplied by the difference of the hospital's occupied bed days less the hospital's Medicare bed days, provided, however, that the amount of $218.38 shall be increased by a uniform percentage to generate an amount equal to 75% of the State share of the payments authorized under Section 5A-12.5, with such increase only taking effect upon the date that a State share for such payments is required under federal law. For the period of April through June 2015, the amount of $218.38 used to calculate the assessment under this paragraph shall, by emergency rule under subsection (s) of Section 5-45 of the Illinois Administrative Procedure Act, be increased by a uniform percentage to generate $20,250,000 in the aggregate for that period from all hospitals subject to the annual assessment under this paragraph. (2) In addition to any other assessments imposed under this Article, effective July 1, 2016 and semi-annually thereafter through June 2018, or as provided in Section 5A-16, in addition to any federally required State share as authorized under paragraph (1), the amount of $218.38 shall be increased by a uniform percentage to generate an amount equal to 75% of the ACA Assessment Adjustment, as defined in subsection (b-6) of this Section. For State fiscal years 2009 through 2018, or as provided in Section 5A-16, a hospital's occupied bed days and Medicare bed days shall be determined using the most recent data available from each hospital's 2005 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on December 31, 2006, without regard to any subsequent adjustments or changes to such data. If a hospital's 2005 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Illinois Department may obtain the hospital provider's occupied bed days and Medicare bed days from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois Department or its duly authorized agents and employees. (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State fiscal years 2019 and 2020, an annual assessment on inpatient services is imposed on each hospital provider in an amount equal to $197.19 multiplied by the difference of the hospital's occupied bed days less the hospital's Medicare bed days. For State fiscal years 2019 and 2020, a hospital's occupied bed days and Medicare bed days shall be determined using the most recent data available from each hospital's 2015 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on March 31, 2017, without regard to any subsequent adjustments or changes to such data. If a hospital's 2015 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Illinois Department may obtain the hospital provider's occupied bed days and Medicare bed days from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois Department or its duly authorized agents and employees. Notwithstanding any other provision in this Article, for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State fiscal year 2018 on the basis of hypothetical data, that assessment amount shall be used for State fiscal years 2019 and 2020. (4) Subject to Sections 5A-3 and 5A-10 and to subsection (b-8), for the period of July 1, 2020 through December 31, 2020 and calendar years 2021 through 2026, an annual assessment on inpatient services is imposed on each hospital provider in an amount equal to $221.50 multiplied by the difference of the hospital's occupied bed days less the hospital's Medicare bed days, provided however: for the period of July 1, 2020 through December 31, 2020, (i) the assessment shall be equal to 50% of the annual amount; and (ii) the amount of $221.50 shall be retroactively adjusted by a uniform percentage to generate an amount equal to 50% of the Assessment Adjustment, as defined in subsection (b-7). For the period of July 1, 2020 through December 31, 2020 and calendar years 2021 through 2026, a hospital's occupied bed days and Medicare bed days shall be determined using the most recent data available from each hospital's 2015 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on March 31, 2017, without regard to any subsequent adjustments or changes to such data. If a hospital's 2015 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Illinois Department may obtain the hospital provider's occupied bed days and Medicare bed days from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois Department or its duly authorized agents and employees. Should the change in the assessment methodology for fiscal years 2021 through December 31, 2022 not be approved on or before June 30, 2020, the assessment and payments under this Article in effect for fiscal year 2020 shall remain in place until the new assessment is approved. If the assessment methodology for July 1, 2020 through December 31, 2022, is approved on or after July 1, 2020, it shall be retroactive to July 1, 2020, subject to federal approval and provided that the payments authorized under Section 5A-12.7 have the same effective date as the new assessment methodology. In giving retroactive effect to the assessment approved after June 30, 2020, credit toward the new assessment shall be given for any payments of the previous assessment for periods after June 30, 2020. Notwithstanding any other provision of this Article, for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State Fiscal Year 2020 on the basis of hypothetical data, the data that was the basis for the 2020 assessment shall be used to calculate the assessment under this paragraph until December 31, 2023. Beginning July 1, 2022 and through December 31, 2024, a safety-net hospital that had a change of ownership in calendar year 2021, and whose inpatient utilization had decreased by 90% from the prior year and prior to the change of ownership, may be eligible to pay a tax based on hypothetical data based on a determination of financial distress by the Department. Subject to federal approval, the Department may, by January 1, 2024, develop a hypothetical tax for a specialty cancer hospital which had a structural change of ownership during calendar year 2022 from a for-profit entity to a non-profit entity, and which has experienced a decline of 60% or greater in inpatient days of care as compared to the prior owners 2015 Medicare cost report. This change of ownership may make the hospital eligible for a hypothetical tax under the new hospital provision of the assessment defined in this Section. This new hypothetical tax may be applicable from January 1, 2024 through December 31, 2026. (b) (Blank).
(b-5)(1) Subject to Sections 5A-3 and 5A-10, for the portion of State fiscal year 2012, beginning June 10, 2012 through June 30, 2012, and for State fiscal years 2013 through 2018, or as provided in Section 5A-16, an annual assessment on outpatient services is imposed on each hospital provider in an amount equal to .008766 multiplied by the hospital's outpatient gross revenue, provided, however, that the amount of .008766 shall be increased by a uniform percentage to generate an amount equal to 25% of the State share of the payments authorized under Section 5A-12.5, with such increase only taking effect upon the date that a State share for such payments is required under federal law. For the period beginning June 10, 2012 through June 30, 2012, the annual assessment on outpatient services shall be prorated by multiplying the assessment amount by a fraction, the numerator of which is 21 days and the denominator of which is 365 days. For the period of April through June 2015, the amount of .008766 used to calculate the assessment under this paragraph shall, by emergency rule under subsection (s) of Section 5-45 of the Illinois Administrative Procedure Act, be increased by a uniform percentage to generate $6,750,000 in the aggregate for that period from all hospitals subject to the annual assessment under this paragraph. (2) In addition to any other assessments imposed under this Article, effective July 1, 2016 and semi-annually thereafter through June 2018, in addition to any federally required State share as authorized under paragraph (1), the amount of .008766 shall be increased by a uniform percentage to generate an amount equal to 25% of the ACA Assessment Adjustment, as defined in subsection (b-6) of this Section. For the portion of State fiscal year 2012, beginning June 10, 2012 through June 30, 2012, and State fiscal years 2013 through 2018, or as provided in Section 5A-16, a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2009 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on June 30, 2011, without regard to any subsequent adjustments or changes to such data. If a hospital's 2009 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Department may obtain the hospital provider's outpatient gross revenue from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Department or its duly authorized agents and employees. (3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State fiscal years 2019 and 2020, an annual assessment on outpatient services is imposed on each hospital provider in an amount equal to .01358 multiplied by the hospital's outpatient gross revenue. For State fiscal years 2019 and 2020, a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2015 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on March 31, 2017, without regard to any subsequent adjustments or changes to such data. If a hospital's 2015 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Department may obtain the hospital provider's outpatient gross revenue from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Department or its duly authorized agents and employees. Notwithstanding any other provision in this Article, for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State fiscal year 2018 on the basis of hypothetical data, that assessment amount shall be used for State fiscal years 2019 and 2020. (4) Subject to Sections 5A-3 and 5A-10 and to subsection (b-8), for the period of July 1, 2020 through December 31, 2020 and calendar years 2021 through 2026, an annual assessment on outpatient services is imposed on each hospital provider in an amount equal to .01525 multiplied by the hospital's outpatient gross revenue, provided however: (i) for the period of July 1, 2020 through December 31, 2020, the assessment shall be equal to 50% of the annual amount; and (ii) the amount of .01525 shall be retroactively adjusted by a uniform percentage to generate an amount equal to 50% of the Assessment Adjustment, as defined in subsection (b-7). For the period of July 1, 2020 through December 31, 2020 and calendar years 2021 through 2026, a hospital's outpatient gross revenue shall be determined using the most recent data available from each hospital's 2015 Medicare cost report as contained in the Healthcare Cost Report Information System file, for the quarter ending on March 31, 2017, without regard to any subsequent adjustments or changes to such data. If a hospital's 2015 Medicare cost report is not contained in the Healthcare Cost Report Information System, then the Illinois Department may obtain the hospital provider's outpatient revenue data from any source available, including, but not limited to, records maintained by the hospital provider, which may be inspected at all times during business hours of the day by the Illinois Department or its duly authorized agents and employees. Should the change in the assessment methodology above for fiscal years 2021 through calendar year 2022 not be approved prior to July 1, 2020, the assessment and payments under this Article in effect for fiscal year 2020 shall remain in place until the new assessment is approved. If the change in the assessment methodology above for July 1, 2020 through December 31, 2022, is approved after June 30, 2020, it shall have a retroactive effective date of July 1, 2020, subject to federal approval and provided that the payments authorized under Section 12A-7 have the same effective date as the new assessment methodology. In giving retroactive effect to the assessment approved after June 30, 2020, credit toward the new assessment shall be given for any payments of the previous assessment for periods after June 30, 2020. Notwithstanding any other provision of this Article, for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State Fiscal Year 2020 on the basis of hypothetical data, the data that was the basis for the 2020 assessment shall be used to calculate the assessment under this paragraph until December 31, 2023. Beginning July 1, 2022 and through December 31, 2024, a safety-net hospital that had a change of ownership in calendar year 2021, and whose inpatient utilization had decreased by 90% from the prior year and prior to the change of ownership, may be eligible to pay a tax based on hypothetical data based on a determination of financial distress by the Department. (b-6)(1) As used in this Section, "ACA Assessment Adjustment" means: (A) For the period of July 1, 2016 through December | ||
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(B) For the period of January 1, 2017 through June | ||
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(C) For the period of July 1, 2017 through December | ||
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(D) For the period of January 1, 2018 through June | ||
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(i) the amount calculated under this subparagraph | ||
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(ii) the amount calculated under this | ||
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(2) The Department shall complete and apply a final reconciliation of the ACA Assessment Adjustment prior to June 30, 2018 to account for: (A) any differences between the actual payments | ||
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(B) any difference between the estimated | ||
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The Department shall notify hospitals of any additional amounts owed or reduction credits to be applied to the June 2018 ACA Assessment Adjustment. This is to be considered the final reconciliation for the ACA Assessment Adjustment. (3) Notwithstanding any other provision of this Section, if for any reason the scheduled payments under subsection (b) of Section 5A-12.5 are not issued in full by the final day of the period authorized under subsection (b) of Section 5A-12.5, funds collected from each hospital pursuant to subparagraph (D) of paragraph (1) and pursuant to paragraph (2), attributable to the scheduled payments authorized under subsection (b) of Section 5A-12.5 that are not issued in full by the final day of the period attributable to each payment authorized under subsection (b) of Section 5A-12.5, shall be refunded. (4) The increases authorized under paragraph (2) of subsection (a) and paragraph (2) of subsection (b-5) shall be limited to the federally required State share of the total payments authorized under Section 5A-12.5 if the sum of such payments yields an annualized amount equal to or less than $450,000,000, or if the adjustments authorized under subsection (t) of Section 5A-12.2 are found not to be actuarially sound; however, this limitation shall not apply to the fee-for-service payments described in subsection (b) of Section 5A-12.5. (b-7)(1) As used in this Section, "Assessment Adjustment" means: (A) For the period of July 1, 2020 through | ||
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(B) For each calendar quarter beginning January 1, | ||
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(C) Beginning on January 1, 2023, and each subsequent | ||
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(2) The Department shall calculate and notify each hospital of the total Assessment Adjustment and any additional assessment owed by the hospital or refund owed to the hospital on either a semi-annual or annual basis. Such notice shall be issued at least 30 days prior to any period in which the assessment will be adjusted. Any additional assessment owed by the hospital or refund owed to the hospital shall be uniformly applied to the assessment owed by the hospital in monthly installments for the subsequent semi-annual period or calendar year. If no assessment is owed in the subsequent year, any amount owed by the hospital or refund due to the hospital, shall be paid in a lump sum. (3) The Department shall publish all details of the Assessment Adjustment calculation performed each year on its website within 30 days of completing the calculation, and also submit the details of the Assessment Adjustment calculation as part of the Department's annual report to the General Assembly. (b-8) Notwithstanding any other provision of this Article, the Department shall reduce the assessments imposed on each hospital under subsections (a) and (b-5) by the uniform percentage necessary to reduce the total assessment imposed on all hospitals by an aggregate amount of $240,000,000, with such reduction being applied by June 30, 2022. The assessment reduction required for each hospital under this subsection shall be forever waived, forgiven, and released by the Department. (c) (Blank).
(d) Notwithstanding any of the other provisions of this Section, the Department is authorized to adopt rules to reduce the rate of any annual assessment imposed under this Section, as authorized by Section 5-46.2 of the Illinois Administrative Procedure Act.
(e) Notwithstanding any other provision of this Section, any plan providing for an assessment on a hospital provider as a permissible tax under Title XIX of the federal Social Security Act and Medicaid-eligible payments to hospital providers from the revenues derived from that assessment shall be reviewed by the Illinois Department of Healthcare and Family Services, as the Single State Medicaid Agency required by federal law, to determine whether those assessments and hospital provider payments meet federal Medicaid standards. If the Department determines that the elements of the plan may meet federal Medicaid standards and a related State Medicaid Plan Amendment is prepared in a manner and form suitable for submission, that State Plan Amendment shall be submitted in a timely manner for review by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services and subject to approval by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. No such plan shall become effective without approval by the Illinois General Assembly by the enactment into law of related legislation. Notwithstanding any other provision of this Section, the Department is authorized to adopt rules to reduce the rate of any annual assessment imposed under this Section. Any such rules may be adopted by the Department under Section 5-50 of the Illinois Administrative Procedure Act. (Source: P.A. 102-886, eff. 5-17-22; 103-102, eff. 1-1-24 .)
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(305 ILCS 5/5A-2.1) Sec. 5A-2.1. Continuation of Section 5A-2 of this Code; validation. (a) The General Assembly finds and declares that: (1) Public Act 101-650, which took effect on July 7, | ||
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(2) The Statute on Statutes sets forth general rules | ||
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(3) This amendatory Act of the 101st General Assembly | ||
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(b) Any construction of this Code that results in the repeal of Section 5A-2 of this Code on July 1, 2020 would be inconsistent with the manifest intent of the General Assembly and repugnant to the context of this Code. (c) It is hereby declared to have been the intent of the General Assembly that Section 5A-2 of this Code shall not be subject to repeal on July 1, 2020. (d) Section 5A-2 of this Code shall be deemed to have been in continuous effect since July 8, 1992 (the effective date of Public Act 87-861), and it shall continue to be in effect, as amended by Public Act 101-650, until it is otherwise lawfully amended or repealed. All previously enacted amendments to the Section taking effect on or after July 8, 1992, are hereby validated. (e) In order to ensure the continuing effectiveness of Section 5A-2 of this Code, that Section is set forth in
full and reenacted by this amendatory Act of the 101st General
Assembly. In this amendatory Act of the 101st General Assembly, the base text of the reenacted Section is set forth as amended by Public Act 101-650. (f) All actions of the Illinois Department or any other person or entity taken in reliance on or pursuant to Section 5A-2 of this Code are hereby validated.
(Source: P.A. 101-655, eff. 3-12-21.) |
(305 ILCS 5/5A-3) (from Ch. 23, par. 5A-3)
Sec. 5A-3. Exemptions.
(a) (Blank).
(b) A hospital provider that is a State agency, a State university, or
a county
with a population of 3,000,000 or more is exempt from the assessment imposed
by Section 5A-2.
(b-2) A hospital provider
that is a county with a population of less than 3,000,000 or a
township,
municipality,
hospital district, or any other local governmental unit is exempt from the
assessment
imposed by Section 5A-2.
(b-5) (Blank).
(b-10) (Blank).
(b-15) (Blank).
(b-20) (Blank).
(b-25) (Blank).
(c) (Blank).
(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
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(305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4) Sec. 5A-4. Payment of assessment; penalty.
(a) The assessment imposed by Section 5A-2 for State fiscal year 2009 through State fiscal year 2018 or as provided in Section 5A-16, shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the fourteenth State business day of each month.
No installment payment of an assessment imposed by Section 5A-2 shall be due
and
payable, however, until after the Comptroller has issued the payments required under this Article.
Except as provided in subsection (a-5) of this Section, the assessment imposed by subsection (b-5) of Section 5A-2 for the portion of State fiscal year 2012 beginning June 10, 2012 through June 30, 2012, and for State fiscal year 2013 through State fiscal year 2018 or as provided in Section 5A-16, shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the 17th State business day of each month. No installment payment of an assessment imposed by subsection (b-5) of Section 5A-2 shall be due and payable, however, until after: (i) the Department notifies the hospital provider, in writing, that the payment methodologies to hospitals required under Section 5A-12.4, have been approved by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services, and the waiver under 42 CFR 433.68 for the assessment imposed by subsection (b-5) of Section 5A-2, if necessary, has been granted by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services; and (ii) the Comptroller has issued the payments required under Section 5A-12.4. Upon notification to the Department of approval of the payment methodologies required under Section 5A-12.4 and the waiver granted under 42 CFR 433.68, if necessary, all installments otherwise due under subsection (b-5) of Section 5A-2 prior to the date of notification shall be due and payable to the Department upon written direction from the Department and issuance by the Comptroller of the payments required under Section 5A-12.4. Except as provided in subsection (a-5) of this Section, the assessment imposed under Section 5A-2 for State fiscal year 2019 and each subsequent State fiscal year shall be due and payable in monthly installments, each equaling one-twelfth of the assessment for the year, on the 17th State business day of each month. The Department has discretion to establish a later date due to delays in payments being made to hospitals as required under Section 5A-12.7. No installment payment of an assessment imposed by Section 5A-2 shall be due and payable, however, until after: (i) the Department notifies the hospital provider, in writing, that the payment methodologies to hospitals required under Section 5A-12.6 or 5A-12.7 have been approved by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services, and the waiver under 42 CFR 433.68 for the assessment imposed by Section 5A-2, if necessary, has been granted by the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services; and (ii) the Comptroller and managed care organizations have issued the payments required under Section 5A-12.6 or 5A-12.7. Upon notification to the Department of approval of the payment methodologies required under Section 5A-12.6 or 5A-12.7 and the waiver granted under 42 CFR 433.68, if necessary, all installments otherwise due under Section 5A-2 prior to the date of notification shall be due and payable to the Department upon written direction from the Department and issuance by the Comptroller and managed care organizations of the payments required under Section 5A-12.6 or 5A-12.7. (a-5) The Illinois Department may accelerate the schedule upon which assessment installments are due and payable by hospitals with a payment ratio greater than or equal to one. Such acceleration of due dates for payment of the assessment may be made only in conjunction with a corresponding acceleration in access payments identified in Section 5A-12.2, Section 5A-12.4, Section 5A-12.6, or Section 5A-12.7 to the same hospitals. For the purposes of this subsection (a-5), a hospital's payment ratio is defined as the quotient obtained by dividing the total payments for the State fiscal year, as authorized under Section 5A-12.2, Section 5A-12.4, Section 5A-12.6, or Section 5A-12.7, by the total assessment for the State fiscal year imposed under Section 5A-2 or subsection (b-5) of Section 5A-2. (b) The Illinois Department is authorized to establish
delayed payment schedules for hospital providers that are unable
to make installment payments when due under this Section due to
financial difficulties, as determined by the Illinois Department.
(c) If a hospital provider fails to pay the full amount of
an installment when due (including any extensions granted under
subsection (b)), there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment
imposed by Section 5A-2 a penalty
assessment equal to the lesser of (i) 5% of the amount of the
installment not paid on or before the due date plus 5% of the
portion thereof remaining unpaid on the last day of each 30-day period
thereafter or (ii) 100% of the installment amount not paid on or
before the due date. For purposes of this subsection, payments
will be credited first to unpaid installment amounts (rather than
to penalty or interest), beginning with the most delinquent
installments.
(d) Any assessment amount that is due and payable to the Illinois Department more frequently than once per calendar quarter shall be remitted to the Illinois Department by the hospital provider by means of electronic funds transfer. The Illinois Department may provide for remittance by other means if (i) the amount due is less than $10,000 or (ii) electronic funds transfer is unavailable for this purpose. (Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19; 101-209, eff. 8-5-19; 101-650, eff. 7-7-20.) |
(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5) Sec. 5A-5. Notice; penalty; maintenance of records.
(a)
The Illinois Department shall send a
notice of assessment to every hospital provider subject
to assessment under this Article. The notice of assessment shall notify the hospital of its assessment and shall be sent after receipt by the Department of notification from the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services that the payment methodologies required under this Article and, if necessary, the waiver granted under 42 CFR 433.68 have been approved. The notice
shall be on a form
prepared by the Illinois Department and shall state the following:
(1) The name of the hospital provider.
(2) The address of the hospital provider's principal | ||
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(3) The occupied bed days, occupied bed days less | ||
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(4) (Blank).
(5) Other reasonable information as determined by the | ||
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(b) If a hospital provider conducts, operates, or
maintains more than one hospital licensed by the Illinois
Department of Public Health, the provider shall pay the
assessment for each hospital separately.
(c) Notwithstanding any other provision in this Article, in
the case of a person who ceases to conduct, operate, or maintain a
hospital in respect of which the person is subject to assessment
under this Article as a hospital provider, the assessment for the State
fiscal year in which the cessation occurs shall be adjusted by
multiplying the assessment computed under Section 5A-2 by a
fraction, the numerator of which is the number of days in the
year during which the provider conducts, operates, or maintains
the hospital and the denominator of which is 365. Immediately
upon ceasing to conduct, operate, or maintain a hospital, the person
shall pay the assessment
for the year as so adjusted (to the extent not previously paid).
(d) Notwithstanding any other provision in this Article, a
provider who commences conducting, operating, or maintaining a
hospital, upon notice by the Illinois Department,
shall pay the assessment computed under Section 5A-2 and
subsection (e) in installments on the due dates stated in the
notice and on the regular installment due dates for the State
fiscal year occurring after the due dates of the initial
notice.
(e)
Notwithstanding any other provision in this Article, for State fiscal years 2009 through 2018, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in 2005, the assessment for that State fiscal year shall be computed on the basis of hypothetical occupied bed days for the full calendar year as determined by the Illinois Department. Notwithstanding any other provision in this Article, for the portion of State fiscal year 2012 beginning June 10, 2012 through June 30, 2012, and for State fiscal years 2013 through 2018, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in 2009, the assessment under subsection (b-5) of Section 5A-2 for that State fiscal year shall be computed on the basis of hypothetical gross outpatient revenue for the full calendar year as determined by the Illinois Department.
Notwithstanding any other provision in this Article, beginning July 1, 2018 through December 31, 2026, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in the year that is the basis of the calculation of the assessment under this Article, the assessment under paragraph (3) of subsection (a) of Section 5A-2 for the State fiscal year shall be computed on the basis of hypothetical occupied bed days for the full calendar year as determined by the Illinois Department, except that for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State fiscal year 2018 on the basis of hypothetical data, that assessment amount shall be used for State fiscal years 2019 and 2020; however, for State fiscal year 2020, the assessment amount shall be increased by the proportion that it represents of the total annual assessment that is generated from all hospitals in order to generate $6,250,000 in the aggregate for that period from all hospitals subject to the annual assessment under this paragraph. Notwithstanding any other provision in this Article, beginning July 1, 2018 through December 31, 2026, in the case of a hospital provider that did not conduct, operate, or maintain a hospital in the year that is the basis of the calculation of the assessment under this Article, the assessment under subsection (b-5) of Section 5A-2 for that State fiscal year shall be computed on the basis of hypothetical gross outpatient revenue for the full calendar year as determined by the Illinois Department, except that for a hospital provider that did not have a 2015 Medicare cost report, but paid an assessment in State fiscal year 2018 on the basis of hypothetical data, that assessment amount shall be used for State fiscal years 2019 and 2020; however, for State fiscal year 2020, the assessment amount shall be increased by the proportion that it represents of the total annual assessment that is generated from all hospitals in order to generate $6,250,000 in the aggregate for that period from all hospitals subject to the annual assessment under this paragraph. (f) Every hospital provider subject to assessment under this Article shall keep sufficient records to permit the determination of adjusted gross hospital revenue for the hospital's fiscal year. All such records shall be kept in the English language and shall, at all times during regular business hours of the day, be subject to inspection by the Illinois Department or its duly authorized agents and employees.
(g) The Illinois Department may, by rule, provide a hospital provider a reasonable opportunity to request a clarification or correction of any clerical or computational errors contained in the calculation of its assessment, but such corrections shall not extend to updating the cost report information used to calculate the assessment.
(h) (Blank).
(Source: P.A. 102-886, eff. 5-17-22.)
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(305 ILCS 5/5A-6) (from Ch. 23, par. 5A-6)
Sec. 5A-6. Disposition of proceeds. The Illinois Department
shall deposit all moneys received from hospital providers under this
Article into the Hospital Provider Fund. Upon certification by
the Illinois Department to the State Comptroller of its intent to
withhold payments from a provider pursuant to Section 5A-7(b), the State
Comptroller shall draw a warrant on the treasury or other fund
held by the State Treasurer, as appropriate. The warrant shall
state the amount for which the provider is entitled to a
warrant, the amount of the deduction, and the reason therefor and
shall direct the State Treasurer to pay the balance to the provider,
all in accordance with Section 10.05 of the State Comptroller Act.
The warrant also shall direct the State Treasurer to transfer the amount of the
deduction so ordered from the treasury or other fund into the
Hospital Provider Fund.
(Source: P.A. 97-689, eff. 6-14-12.)
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(305 ILCS 5/5A-7) (from Ch. 23, par. 5A-7)
Sec. 5A-7. Administration; enforcement provisions.
(a) The Illinois Department shall establish and maintain a listing of all hospital providers appearing in the licensing records of the Illinois Department of Public Health, which shall show each provider's name and principal place of business and the name and address of each hospital operated, conducted, or maintained by the provider in this State. The Illinois Department shall administer and enforce this Article and collect the assessments and penalty assessments imposed under this Article using procedures employed in its administration of this Code generally. The Illinois Department, its Director, and every hospital provider subject to assessment under this Article shall have the following powers, duties, and rights: (1) The Illinois Department may initiate either | ||
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(2) No proceedings for collection, refund, credit, or | ||
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(3) Any unpaid assessment under this Article shall | ||
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(4) Payments under this Article are not subject to | ||
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(b) In addition to any other remedy provided for and without sending a notice of assessment liability, the Illinois Department may collect an unpaid assessment by withholding, as payment of the assessment, reimbursements or other amounts otherwise payable by the Illinois Department to the hospital provider.
(Source: P.A. 93-659, eff. 2-3-04; 93-841, eff. 7-30-04; 94-242, eff. 7-18-05.)
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(305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
Sec. 5A-8. Hospital Provider Fund.
(a) There is created in the State Treasury the Hospital Provider Fund.
Interest earned by the Fund shall be credited to the Fund. The
Fund shall not be used to replace any moneys appropriated to the
Medicaid program by the General Assembly.
(b) The Fund is created for the purpose of receiving moneys
in accordance with Section 5A-6 and disbursing moneys only for the following
purposes, notwithstanding any other provision of law:
(1) For making payments to hospitals as required | ||
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(2) For the reimbursement of moneys collected by the | ||
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(3) For payment of administrative expenses incurred | ||
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(4) For payments of any amounts which are | ||
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(5) For making transfers, as those transfers are | ||
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(6) For making transfers to any other fund in the | ||
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(6.5) For making transfers to the Healthcare Provider | ||
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(7) For making transfers not exceeding the following | ||
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Health and Human Services Medicaid Trust Fund
$20,000,000 Long-Term Care Provider Fund
$30,000,000 General Revenue Fund
$80,000,000. Transfers under this paragraph shall be made within 7 | ||
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(7.1) (Blank).
(7.5) (Blank). (7.8) (Blank). (7.9) (Blank). (7.10) For State fiscal year 2014, for making | ||
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Healthcare Provider Relief Fund
$100,000,000 Transfers under this paragraph shall be made within 7 | ||
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The additional amount of transfers in this paragraph | ||
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(7.10a) For State fiscal years 2015 through 2018, for | ||
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Healthcare Provider Relief Fund
$50,000,000 Transfers under this paragraph shall be made within 7 | ||
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(7.11) (Blank). (7.12) For State fiscal year 2013, for increasing by | ||
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Healthcare Provider Relief Fund
$2,870,000 Since the federal Centers for Medicare and Medicaid | ||
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(7.13) In addition to any other transfers authorized | ||
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(7.14) For making transfers not exceeding the | ||
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Health and Human Services Medicaid Trust Fund
$20,000,000 Long-Term Care Provider Fund
$30,000,000 Healthcare Provider Relief Fund
$325,000,000. Transfers under this paragraph shall be made within 7 | ||
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(7.15) For making transfers not exceeding the | ||
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Health and Human Services Medicaid Trust Fund
$20,000,000 Long-Term Care Provider Fund
$30,000,000 Healthcare Provider Relief Fund
$365,000,000 (7.16) For making transfers not exceeding the | ||
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Health and Human Services Medicaid Trust Fund
$10,000,000 Long-Term Care Provider Fund
$15,000,000 Healthcare Provider Relief Fund
$182,500,000 (8) For making refunds to hospital providers pursuant | ||
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(9) For making payment to capitated managed care | ||
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Disbursements from the Fund, other than transfers authorized under
paragraphs (5) and (6) of this subsection, shall be by
warrants drawn by the State Comptroller upon receipt of vouchers
duly executed and certified by the Illinois Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois | ||
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(2) All federal matching funds received by the | ||
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(3) Any interest or penalty levied in conjunction | ||
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(3.5) As applicable, proceeds from surety bond | ||
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(4) Moneys transferred from another fund in the State | ||
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(5) All other moneys received for the Fund from any | ||
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(d) (Blank).
(Source: P.A. 101-650, eff. 7-7-20; 102-886, eff. 5-17-22.)
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(305 ILCS 5/5A-9) (from Ch. 23, par. 5A-9)
Sec. 5A-9. Emergency services audits. The Illinois Department may
audit hospital claims for payment for emergency services provided to a
recipient who does not require admission as an inpatient. The Illinois
Department shall adopt rules that describe how the emergency services audit
process will be conducted. These rules shall include, but need not be
limited to, the following provisions:
(1) The determination that an emergency medical | ||
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(2) The Illinois Department or its authorized | ||
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(3) An emergency services audit shall be limited to a | ||
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(4) Where the purpose of the audit is to determine | ||
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(5) The preliminary audit findings shall be provided | ||
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(6) The Illinois Department or its designated review | ||
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(Source: P.A. 97-48, eff. 6-28-11.)
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(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
Sec. 5A-10. Applicability.
(a) The assessment imposed by subsection (a) of Section 5A-2 shall cease to be imposed and the Department's obligation to make payments shall immediately cease, and
any moneys
remaining in the Fund shall be refunded to hospital providers
in proportion to the amounts paid by them, if:
(1) The payments to hospitals required under this | ||
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(2) For State fiscal years 2009 through 2018, and as | ||
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(A) any changes for hospitals described in | ||
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(B) any rates for payments made under this | ||
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(C) any changes proposed in State plan amendment | ||
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(D) in relation to any admissions on or after | ||
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(E) any changes affecting hospitals authorized by | ||
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(F) any changes authorized by Section 14-12 of | ||
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(G) any changes authorized under Section 5-5b.1. (b) The assessment imposed by Section 5A-2 shall not take effect or
shall
cease to be imposed, and the Department's obligation to make payments shall immediately cease, if the assessment is determined to be an impermissible
tax under Title XIX
of the Social Security Act. Moneys in the Hospital Provider Fund derived
from assessments imposed prior thereto shall be
disbursed in accordance with Section 5A-8 to the extent federal financial participation is
not reduced due to the impermissibility of the assessments, and any
remaining
moneys shall be
refunded to hospital providers in proportion to the amounts paid by them.
(c) The assessments imposed by subsection (b-5) of Section 5A-2 shall not take effect or shall cease to be imposed, the Department's obligation to make payments shall immediately cease, and any moneys remaining in the Fund shall be refunded to hospital providers in proportion to the amounts paid by them, if the payments to hospitals required under Section 5A-12.4 or Section 5A-12.6 are not eligible for federal matching funds under Title XIX of the Social Security Act. (d) The assessments imposed by Section 5A-2 shall not take effect or shall cease to be imposed, the Department's obligation to make payments shall immediately cease, and any moneys remaining in the Fund shall be refunded to hospital providers in proportion to the amounts paid by them, if: (1) for State fiscal years 2013 through 2018, and as | ||
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(2) for State fiscal years 2013 through 2018, and as | ||
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(3) for State fiscal years 2015 through 2018, and as | ||
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(e) In State fiscal year 2019 through State fiscal year 2020, the assessments imposed under Section 5A-2 shall not take effect or shall cease to be imposed, the Department's obligation to make payments shall immediately cease, and any moneys remaining in the Fund shall be refunded to hospital providers in proportion to the amounts paid by them, if: (1) the payments to hospitals required under Section | ||
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(2) the Department reduces the overall effective | ||
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(f) Beginning in State Fiscal Year 2021, the assessments imposed under Section 5A-2 shall not take effect or shall cease to be imposed, the Department's obligation to make payments shall immediately cease, and any moneys remaining in the Fund shall be refunded to hospital providers in proportion to the amounts paid by them, if: (1) the payments to hospitals required under Section | ||
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(2) the Department reduces the overall effective rate | ||
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(Source: P.A. 101-650, eff. 7-7-20; 102-886, eff. 5-17-22.)
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(305 ILCS 5/5A-11) (from Ch. 23, par. 5A-11)
Sec. 5A-11.
Severability.
If any clause, sentence, Section,
exemption, provision, or part of this Article or the application
thereof to any person or circumstance shall be adjudged to be
unconstitutional or otherwise invalid, the remainder of this
Article or its application to persons or circumstances other than
those to which it is held invalid shall not be affected thereby.
This Article V-A is intended to be separate from and independent
of Articles V-B and V-C, and the application and validity of
this Article V-A shall not be affected by the invalidity of one or
more of Articles V-B and V-C.
(Source: P.A. 87-861.)
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